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The Sunday Special: The Eye Saga Continues

I didn’t want to take up space in a regular column to talk about my ongoing adventures with my eyes. However, a lot of people have asked me to keep them posted about how things are developing. (First article with new hard lens in right eye, Left eye in recovery from surgery, mostly useless for another month…) Here’s the whole story from the beginning so it all hangs together…

Patient Background

Patient is a 67 year old male type A who had cataracts removed from both eyes in 1979 and 1980.

When removed, the status of lens implants had not been established, so lens implants (Alcon) were not installed until 1991.

The right eye had been experiencing some deterioration of corneal function and had declined to 20-100 area, even with implant and correction.

Left eye had been running 20-20 to 20-15 and the patient enjoyed an active lifestyle.

Accidental Dislocation

On April 14. the patient jumped off his tractor to life a heavy piece of concrete into the loader bucket. After a mighty strain, which moved the concrete, the patient stood up and was immediately beset by double-vision in the previously 20-20 to 20-15 eye.

And inspection by a local doctor revealed the left Alcon implant had slipped and it would need to be surgically repositioned.

The patient was given the choice of a local doctor of visiting a specialty clinic. Patient chose the latter.

Surgery

On April 28, the left eye was operated on in Tyler, TX.

The attempt to reposition the old implant was not successful. After 25-years of service, it was too well attached to be positioned where it would not cause glare. The surgeon decided to remove the old lens completely, which required a larger incision. Some preparations for the new implant – which would be installed in a further operation – were also completed.

Time of the operation: Approximately 2.5 hours, done on an outpatient basis.

Follow-up:

On April 29, the day following surgery, the left eye was recovering satisfactorily. Drops were instilled each 2-hours for prednisone and for a wide spectrum antibiotic.

At the May 6 follow-up, the corneal of the left (operative) eye was showing some ulceration. The surgeon estimated a 70% chance this was caused by the non-steroidal anti inflammatory drops.

He applied a clear contact over the corneal, decreased the prednisone and antibiotic to 4X daily and stopped the NSAID completely. A follow-u[ after the weekend was planned.

Right Eye Management

The patient works long hours in a computer environment and needs good vision for work.

As a result, a specialized gas-permeable hard lens (which will ride on the corneal imperfection of the right eye from previous surgery) was fitted by a different specialist, also on May 6 in Tyler.

The gas permeable hard lens is presently correcting to 20-30/20-40 (good enough for flying, by the way) and will likely correct to 20-25, or better, as the eye becomes accustomed to the new hard contact.

For the first two days (starting May 7) the hard lens is worn 2-hours per day in the right eye, after which it is back to a soft contact and glasses (20-100) in the right eye. Each two days, the use of the hard lens can be increased by 1-hour. So May 9, its use will increase to 3-hours per day.

Over time, the right lens will work up to 12-hours per day, as the eye adjusts (depending on how it tolerates the hard lens). As a fall-back position, a new larger hard lens may be used, but these are more difficult for technical reasons. The hard lens cost is $120 each where as the super lens (that covers all the way out to the whites of the eye) is about $450 each.

Outlook

The next appointment for the eyes comes Monday morning at 10AM. At that time, the surgeon will see if the ulcer is clearing (under the clear protective contact) – he expects it will.

However, if it is not responding, the clear plain contact will be replaced with a special corneal treatment lens which is much more expensive ($1,800, but Medicare will pick up 80% of that).

If, as expected however, the eye is continuing to improve (and the ulcer improves) then we should be on track for the replacement implant operation to take place in 2-4 weeks.

With the time-building increasing on the right eye and with the outlook for the implant in the left eye to be done in early June, normal recovery rates suggests two eyes will be 20-20/20-25 with new corrections by early July.

At that time, a vacation to “see some sights” is being planned.

Key Learning Points

1. Medicare is really Great.

I won’t go on too long on this point, except to say that except for about $600 in out of pocket costs (so far, it will be more, likely $1,500 or more before completion), Medicare has been very good.

There are some things not covered, such as refractions for the glasses.

Another surprise is that the Part D Supplement people are being pissy about not paying for the high-end latest and greatest wide spectrum antibiotic. :”Too New” or some such poppycock was their excuse.

2. You need ready cash Reserves over 65

I have always assumed that out health would begin to run into rough spots once over 65 – and sure enough, this is the second one. The first patch was some chiropractic work Elaine needed to have done.

How much is a “good amount” to have in hand for the “Oh shit” moments?

I don’t know of a hard and fast rule, but we plan to keep $10-$15K liquid (if needed as a transfer from a trading account) into checking and credit cards.

True, we may never need it, but even with Medicare paying a good bit of healthcare coats, there are enough problems with insurance (like our “not covered as too new” problem with the optical antibiotics) that you may end up making several $300 out of pocket expenses while you go down the road to healing.

With another trip to the medical labyrinth coming Monday, we’ll keep you posted on developments as they happen, but it’s been an interesting process. And worth sharing in some detail because almost everyone will have eye problems if they to be old enough.

The science is coming along great – and we’re very pleased with our doctors. But if we had not found what we needed in Tyler, then it would have been off to Dallas or Houston…and again, it’s that kind of contingency that can really drain the cash reserves, if you go into being elderly (sheesh, who would have thought, huh?) without planning at least a bit for it.

Here’s hoping you don’t have this kind of experience yourself, but forewarned is forearmed…of bicep’ed or something…

Thanks for the update. Your experience is truly difficult, and you’re handling it admirably. Best of luck to the best of vision.

Let’s put the word “elderly” up there with the “n-word”. It’s dehumanizing. Refer to us older folks as “elders” or “older folks”, but never the e-word. It implies frail and worthless, and most of us are not worthless.

So glad your prognosis is good, George. I would really miss your daily missives, most of which I am pretty much in agreement with. Just remember, all of us boomers, we are retiring by the thousands daily, will likely become too much of a drain on our ponzi system within the next decade. If I were you, I wouldn’t think about moving. You are pretty well set up. And, you have a partner that loves you. You’ve done good! May the all seeing eye shine upon you for all you have given us.

I’m also in the medicare/A/B/D group, a retired MD. I ask my Docs the costs and alternatives when discussing meds. Sometimes the not-so-latest Rx’s will work quite well, for a much decreased out-of-pocket. And sometimes a shorter list of side effects.